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Get Illinois Vegetable And Seed Permit Form

APPLICATION FOR ILLINOIS AGRICULTURE AND VEGETABLE SEED PERMIT MAIL TO New Permit Illinois Department of Agriculture Bureau of Agricultural Products Inspection P. O. Box 19281 - State Fairgrounds Springfield Illinois 62794-9281 Phone 217/782-3817 Renewal Permit IF THE PREPRINTED LABEL IS INCORRECT PLEASE PROVIDE CORRECTIONS BELOW Information will appear on permit Name person firm or corporation Phone area code number Address number and street city state and zip code county Application is hereby made by the undersigned for an agricultural and vegetable seed permit number for the fiscal year ending June 30. The classification of the permit requested is marked below and remittance is hereby made in the amount of. Retail Seed Dealer 10. 00 Wholesale Seed Dealer 30. 00 Seed Broker Seed Merchant signature date 40. 00 REMARKS Operator s of Public Auction Sale or similar type of Consignment Sale Leave Blank Office Use Only Permit Number Date Issued ILLINOIS DISPOSITION REPORT - Mandatory for renewal of permit Type of Crop Sold as Seed Disposed of As Grain Other Means of Disposal Specify Corn Soybeans Wheat Oats Veg. Seed Notice Percentages for each type of crop should total 100 Below list companies grain is sold to PLEASE KEEP DUPLICATE FOR YOUR FILES IMPORTANT NOTICE This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under Illinois Compiled Statutes 505 ILCS 110/1. Failure to provide this information shall prevent this form from being processed* In accordance with the Americans with Disabilities Act any attendee requiring a reasonable accommodation should notify us of their needs. The classification of the permit requested is marked below and remittance is hereby made in the amount of. Retail Seed Dealer 10. 00 Wholesale Seed Dealer 30. 00 Seed Broker Seed Merchant signature date 40. Retail Seed Dealer 10. 00 Wholesale Seed Dealer 30. 00 Seed Broker Seed Merchant signature date 40. 00 REMARKS Operator s of Public Auction Sale or similar type of Consignment Sale Leave Blank Office Use Only Permit Number Date Issued ILLINOIS DISPOSITION REPORT - Mandatory for renewal of permit Type of Crop Sold as Seed Disposed of As Grain Other Means of Disposal Specify Corn Soybeans Wheat Oats Veg. 00 REMARKS Operator s of Public Auction Sale or similar type of Consignment Sale Leave Blank Office Use Only Permit Number Date Issued ILLINOIS DISPOSITION REPORT - Mandatory for renewal of permit Type of Crop Sold as Seed Disposed of As Grain Other Means of Disposal Specify Corn Soybeans Wheat Oats Veg. Seed Notice Percentages for each type of crop should total 100 Below list companies grain is sold to PLEASE KEEP DUPLICATE FOR YOUR FILES IMPORTANT NOTICE This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under Illinois Compiled Statutes 505 ILCS 110/1. Seed Notice Percentages for each type of crop should total 100 Below list companies grain is sold to PLEASE KEEP DUPLICATE FOR YOUR FILES IMPORTANT NOTICE This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under Illinois Compiled Statutes 505 ILCS 110/1. Failure to provide this information shall prevent this form from being processed* In accordance with the Americans with Disabilities Act any attendee requiring a reasonable accommodation should notify us of their needs.

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